Anaesthetic Management In Patient of Myasthenia Gravis Undergoing Thymectomy
Journal Title: International Journal of Medical Science and Innovative Research (IJMSIR) - Year 2018, Vol 3, Issue 10
Abstract
Myasthenia Gravis (MG) is an autoimmune disease of neuromuscular junctions (NMJ). The pathophysiology involves the formation of auto-antibodies against postsynaptic nicotinic acetylcholine (ACh) receptors, thus decreasing their number and making them inadequate to trigger a muscle action potential. It is characterized by weakness and fatigability of skeletal muscles, which usually attenuate after period of rest. We present a case of a 26 years old male patient, weighing 60 kg with chief complaints of difficulty in speech and swallowing, generalized weakness of limbs since 2-3 years. After establishing the diagnosis of MG, patient was posted for thymectomy. Patient was on Pyridostigmine 60mg, tab. Prednisolone 20mg and tab. Azathioprine 50mg as medical treatment for MG. On the day of surgery thoracic epidural was given using 18 gz epidural needle. Pre-oxygenation was done with 100% oxygen for 3 minutes. Induction was done with inj. Midazolam 2mg IV, inj. Fentanyl 80mcg, inj. Propofol 2 mg/kg IV along with 2% sevoflurane as inhalational anaesthetic agent with 100% oxygen. Under direct laryngoscopy, airway was secured with cuffed ETT of size 8mm ID. Propofol infusion was started @ of 10 mg-1h-1 for 30 minutes and gradually tapered to 5 mg-1h-1 thereafter for remaining surgery and top up through epidural catheter to maintain adequate analgesia. Rate of propofol infusion was tapered 20 min prior to surgery. Surgery concluded successfully without the use of muscle relaxant and aborting the need of neostigmine. Patient was extubated successfully and shifted to ICU for further observation.
Authors and Affiliations
Dr Sumedha Vashishth
Keywords
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